Antimanic Medications Anti-manic Drugs
Antimanic Medications Anti-manic Drugs Introduction
(manic-depressive illness) is characterized by cycling mood changes: severe
highs (mania) and lows (depression). Cycles may be predominantly manic or depressive
with normal mood between cycles. Mood swings may follow each other very closely,
within hours or days, or may be separated by months to years. These "highs"
and "lows" may vary in intensity and severity.
When someone is in a manic "high," he may be overactive, overtalkative,
and have a great deal of energy. He will switch quickly from one topic to another,
as if he cannot get his thoughts out fast enough; his attention span is often
short, and he can easily be distracted. Sometimes, the "high" person
is irritable or angry and has false or inflated ideas about his position or
importance in the world. He may be very elated, full of grand schemes which
might range from business deals to romantic sprees. Often, he shows poor judgment
in these ventures. Mania, untreated, may worsen to a psychotic state.
Depression will show
in a "low" mood, lack of energy, changes in eating and sleeping patterns,
feelings of hopelessness, helplessness, sadness, worthlessness, and guilt, and
sometimes thoughts of suicide.
Lithium The medication used most often to combat a manic "high" is
lithium. It is unusual to find mania without a subsequent or preceding period
of depression. Lithium evens out mood swings in both directions, so that it
is used not just for acute manic attacks or flare-ups of the illness, but also
as an ongoing treatment of bipolar disorder. Lithium will diminish severe manic
symptoms in about 5 to 14 days, but it may be anywhere from days to several
months until the condition is fully controlled.
Antipsychotic medications are sometimes used in the first several days of treatment
to control manic symptoms until the lithium begins to take effect. Likewise,
antidepressants may be needed in addition to lithium during the depressive phase
of bipolar disorder. Someone may have one episode of bipolar disorder and never
have another, or be free of illness for several years. However, for those who
have more than one episode, continuing (maintenance) treatment on lithium is
usually given serious consideration. Some people respond well to maintenance
treatment and have no further episodes, while others may have moderate mood
swings that lessen as treatment continues. Some people may continue to have
episodes that are diminished in frequency and severity. Unfortunately, some
manic-depressive patients may not be helped at all. Response to treatment with
lithium varies, and it cannot be determined beforehand who will or will not
respond to treatment.
Regular blood tests are an important part of treatment with lithium. A lithium
level must be checked periodically to measure the amount of the drug in the
body. If too little is taken, lithium will not be effective. If too much is
taken, a variety of side effects may occur. The range between an effective dose
and a toxic one is small. A lithium level is routinely checked at the beginning
of treatment to determine the best lithium dosage for the patient. Once a person
is stable and on maintenance dosage, a lithium level should be checked every
few months. How much lithium a person needs to take may vary over time, depending
on how ill he is, his body chemistry, and his physical condition.
Anything that lowers the level of sodium (table salt is sodium chloride) in
the body may cause a lithium buildup and lead to toxicity. Reduced salt intake,
heavy sweating, fever, vomiting, or diarrhea may do this. An unusual amount
of exercise or a switch to a low-salt diet are examples. It's important to be
aware of conditions that lower sodium and to share this information with the
doctor. The lithium dosage may have to be adjusted.
When a person first takes lithium, he may experience side effects, such as
drowsiness, weakness, nausea, vomiting, fatigue, hand tremor, or increased thirst
and urination. These usually disappear or subside quickly, although hand tremor
may persist. Weight gain may also occur. Dieting will help, but crash diets
should be avoided because they may affect the lithium level. Drinking low-calorie
or no-calorie beverages will help keep weight down. Kidney changes, accompanied
by increased thirst and urination, may develop during treatment. These conditions
that may occur are generally manageable and are reduced by lowering the dosage.
Because lithium may cause the thyroid gland to become underactive (hypothyroidism)
or sometimes enlarged (goiter), thyroid function monitoring is a part of the
therapy. To restore normal thyroid function, thyroid hormone is given along
with lithium. Because of possible complications, lithium may either not be recommended
or may be given with caution when a person has existing thyroid, kidney, or
heart disorders, epilepsy, or brain damage.
Women of child-bearing age should be aware that lithium increases the risk
of congenital malformations in babies born to women taking lithium. Special
caution should be taken during the first 3 months of pregnancy. Lithium, when
combined with certain other medications, can have unwanted effects. Some diuretics
substances that remove water from the body increase the level of lithium and
can cause toxicity. Other diuretics, like coffee and tea, can lower the level
Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental
dullness, slurred speech, confusion, dizziness, muscle twitching, irregular
heart beat, and blurred vision. A serious lithium overdose can be life-threatening.
Someone who is taking lithium should tell all the doctors including dentist
she sees about all other medications he is taking. With regular monitoring,
lithium is a safe and effective drug that enables many people, who otherwise
would suffer from incapacitating mood swings, to lead normal lives.
Anticonvulsants Not all patients with symptoms of mania benefit from lithium.
Some have been found to respond to another type of medication, the anticonvulsant
medications that are usually used to treat epilepsy. Carbamazepine (Tegretol)
is the anticonvulsant that has been most widely used. Manic-depressive patients
who cycle rapidly that is, they change from mania to depression and back again
over the course of hours or days, rather than months seem to respond particularly
well to carbamazepine.
Early side effects of carbamazepine, although generally mild, include drowsiness,
dizziness, confusion, disturbed vision, perceptual distortions, memory impairment,
and nausea. They are usually transient and often respond to temporary dosage
reduction. Another common but generally mild adverse effect is the lowering
of the white blood cell count which requires periodic blood tests to monitor
against the rare possibility of more serious, even life-threatening, bone marrow
depression. Also serious are the skin rashes that can occur in 15 to 20 percent
of patients. These rashes are sometimes severe enough to require discontinuation
of the medication.
In 1995, the anticonvulsant divalproex sodium (Depakote) was approved by the
Food and Drug Administration for manic-depressive illness. Clinical trials have
shown it to have an effectiveness in controlling manic symptoms equivalent to
that of lithium; it is effective in both rapid-cycling and non-rapid-cycling
bipolar. Though divalproex can cause gastrointestinal side effects, the incidence
is low. Other adverse effects occasionally reported are headache, double vision,
dizziness, anxiety, or confusion. Because in some cases divalproex has caused
liver disfunction, liver function tests should be performed prior to therapy
and at frequent intervals thereafter, particularly during the first six months
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